Cancer costs for Americans with private health insurance rose after the ACA rollout and fell for those with Medicaid

Low-income Americans ages 18 to 64 with cancer saved about US$1,250 per year on treatment within seven years of the 2014 rollout of the Affordable Care Act, according to my recent study.

Those patients either personally earned or were in families that made $17,609 or less per year and therefore were eligible for Medicaid, the government’s primary health insurance program for low-income Americans.

But adults under 65 with at least $51,000 in annual income – and private health insurance coverage – saw their costs increase by $3,100 per year during the same period. And that increase magnified the financial havoc cancer can cause.

I am a doctoral candidate in pharmaceutical health outcomes and policy. I conducted this study with two other scholars, Douglas Thornton at the University of Houston and Chan Shen at Penn State.

We wanted to learn how the ACA had changed what cancer patients spend on treatment costs. To find out, we examined data from a U.S. government database spanning the years 2011 to 2020. We excluded people treated for nonmelanoma skin cancer, because it’s more easily treatable than other cancers.

These expenditures included health insurance premiums and out-of-pocket costs such as copays, deductibles, hospital stays, doctor’s office visits, emergency services and home health care services. We compared these costs over the three years before the ACA’s implementation, 2011 to 2013, and the seven years after, 2014 to 2020.

We excluded people 65 or older to focus on patients in the workforce. We also adjusted all costs for inflation, expressing them in 2020 dollars, and took steps to not let insurance status changes affect our results.

Treatment costs for the more than 16 million Americans who were 18 to 64 and had cancer from 2011 to 2020 varied based on their income.

For those eligible for Medicaid, spending fell by about 31% from an average of $4,000 annually in 2014 to $2,750 in 2020.

Cancer patients with at least $51,040 in annual income spent an average of $13,000 annually on health care costs before the ACA’s implementation. Their costs increased by up 24%, an average of $3,120, by 2020.

These people were also more than twice as likely after the ACA’s rollout as before it to spend a large part of their income on health care – making it hard for them to afford other basics such as food and housing.

Cancer treatment costs for people with annual incomes ranging from about $17,600 to $51,000 declined somewhat but not significantly.

Why it matters

About 1.9 million Americans are diagnosed with cancer annually. Treatment costs rose to nearly $210 billion in 2020, up 20% from 2015 levels.

What patients pay varies, based largely on whether they have insurance coverage and what kind it is. Costs for cancer patients also vary based on their treatments and how well they tolerate them. The costs of drugs, doctors appointments and hospital services range widely.

Some patients spend so much on cancer care that they struggle to pay their bills, a situation known as “financial toxicity.” Many cancer survivors owe debts they can’t repay and even lose their homes. It’s common for people who have had cancer to avoid filling prescriptions or getting treatment to curb their spending – endangering their health.

What’s next

New cancer treatments are promising, but many of them are very expensive. In 2022, the average yearly cost of cancer treatments reached $260,000 per patient, compared with $63,500 10 years earlier.

However, not all cancer patients are benefiting from these medical advances. So my research team is now working on creating predictive models to help health care providers match patients to the treatments that they’re most likely to respond well to.

Our primary focus will be on immune checkpoint inhibitors, a newer kind of cancer treatment that helps a patient’s immune system do a better job of attacking cancer cells.

The Research Brief is a short take about interesting academic work.

Olajumoke Olateju does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.